Question

A 44-year-old lady presents to the hospital with a ballottable flank mass. On CT imaging, the mass measures 4 cm. Urine examination shows malignant cells. What is the most appropriate management for her condition?

• A. Partial nephrectomy
• B. Partial nephrectomy + neoadjuvant chemotherapy
• C. Radical nephrectomy
• D. Radical nephrectomy + postoperative radiotherapy

Hint:

For small renal tumors (less than 4 cm), partial nephrectomy is preferred as it preserves kidney function and provides good outcomes. Radical nephrectomy is reserved for larger or more advanced tumors.

Answer 1

The Correct Option is A

The patient presents with a ballottable flank mass, which is likely indicative of a renal mass. The finding of malignant cells in the urine suggests the possibility of renal cell carcinoma (RCC), a common malignant tumor of the kidney. The appropriate management of this condition depends on the size, location, and staging of the tumor, as well as the overall health of the patient.
Partial nephrectomy is the preferred treatment for a localized renal mass, particularly when the tumor is smaller (typically less than 4 cm) and confined to one kidney. This procedure allows for the removal of the tumor while preserving kidney function. This is especially important in younger patients or those with a solitary kidney.
Radical nephrectomy involves the removal of the entire kidney and is typically reserved for larger or more advanced tumors, especially if the tumor has invaded surrounding tissues or if partial nephrectomy is not feasible.
Neoadjuvant chemotherapy is not typically used for RCC, as RCC does not respond well to chemotherapy. Surgical resection is the mainstay of treatment, and chemotherapy is generally reserved for other types of cancer.
Postoperative radiotherapy is not commonly used in the treatment of renal cell carcinoma, as RCC is generally resistant to radiation therapy. Thus, the correct management in this case is Partial nephrectomy, as the tumor is small and confined to the kidney.